Happy New Year! For most Americans, your deductible has reset as of this morning.

Since a reader on here is likely on the hook for their expenses, I’d like to point you to my favorite resources for price data.

Your first stop should be your carrier or TPA website. You probably have to do some digging, but you can find your costs in there.

That should be your first stop because outside of fully-insured plans in Texas and Tennessee, paying a price other than the negotiated rate won’t be credited to your deductible, even if you save money. (Seems poorly thought out, right?)

The next stop should be to see what other fair prices might be for the same service. Because negotiated rates are so highly variable between procedures and providers, the negotiated rate you pay for a service at one doctor could be 10x higher at a different doctor.

The negotiated rate could also be 10x higher than the cash price, which is a good opportunity to consider going outside your plan. You won’t get deductible credit (outside of TN and TX fully-insured plans), but you might save a bunch of money. You’ll want to factor in what you anticipate in overall expenses and the likelihood of hitting your deductible as you make these choices.

You are not required to use your insurance to pay for a claim. In fact, HIPAA, under 45 C.F.R. § 164.522(a) specifically privides that patients have a right to maintain the confidentiality of their health information by paying for services out of pocket and requesting that the information not be shared with their health insurance provider.

So if you make the decision to pay cash instead of using your insurance, that’s your choice, and it should factor in more than just the transactional cost.

But if you want to pay cash instead, here’s where I’d suggest looking for prices:

BILLY – www.trybilly.app. Billy ingests all of the machine readable price files that plans and hospitals are required to post and makes it easy to see actual negotiated and cash prices by CPT or DRG. It costs $9.99/month but allows a small number of free lookups.

fairhealth www.fairhealthconsumer.org – free and with a more broad selection of services (including shoppable physician services and dental), but gives a fair range for prices instead of specific cost data.

Turquoise Health – https://turquoise.health – provides free access to cash pricing and limited insurance pricing for a wide variety of services.

Mark Cuban Cost Plus Drug Company, PBC – https://lnkd.in/es8kbUix – probably impossible for my post to be in your algorithm without you knowing about Cost Plus Drugs, but Mark Cuban’s Public Benefit Company PBM has quickly become a great benchmark for fair pricing for a growing number of drugs. Check to see if you can get the drug here and compare the negotiated cost on your plan.

Any choice to forego insurance coverage and pay cash is personal and should be carefully considered. Hopefully these tools help you figure it out.